Efficacy of super pulsed 905 nm low level laser therapy in the management of traumatic brain injury


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The use of Low Level Laser Therapy to treat traumatic brain injury

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Efficacy of super pulsed 905 nm low level laser therapy in the management of traumatic brain injury

  1. 1. RESEARCHBelow you will find my paper recently published in the World Journal of Neuro Science. I havetreated over 65 patients for headache/migraine symptoms. The Department of Defense (DOD)has asked me to do anything I can to help resolve major healthcare problem (i.e Traumatic BrainInjury (TBI)) which is of course a major concern for the military. Shortly after thatconversation a patient was presented to me with a TBI as a result of being hit with a lead pipe 3-4times. His incapacitating headaches were eliminated in just three treatments.As a result of this publication and the positive clinical studies out of Massachusetts, fourresearchers at the University at Buffalo are preparing to start human trials for Alzheimer’s,Concussion (TBI) and Stroke. We expect these studies to be done before year end and ifsuccessful will be a major breakthrough in medicine, saving the health care system hundreds ofbillions of dollars.WORLD JOURNAL OF NEUROSCIENCE NOVEMBER 2012 WJNSPublished Online November 2012 http://www.Scirp.org/journal/wjnsl/Efficacy of super-pulsed 905 nm Low Level Laser Therapy(LLLT) in the management of traumatic brain injury (TBI):A Case StudyWilliam Stephan, M.D. per 1st Affiliation, Louis J. Banas, B.S., CLT per 1st Affiliation, Matthew Bennett,M.D. per 2nd Affiliation, Huseyin Tunceroglu, MSIV per 3rd Affiliation1st Affiliation: William Stephan M.D., LLC, Buffalo, New York2nd. Affiliation: University of Buffalo School of Medicine and Biomedical Sciences, Buffalo, New YorkEmail: huseyint@buffalo.eduReceived 04 September 2012. significantly reduce pain and induce temporaryAbstract vasodilation in capillaries, which the authorsTraumatic brain injury is a major health concern hypothesize can be used to improve the quality of lifeworldwide with massive financial and social impact. in TBI patients by treating their current symptoms,Conventional treatments primarily focus on the which are predominately migraine-like headaches.prevention of further damage to the brain This case report illustrates the use of LLLT in theparenchyma, while failing to address the already treatment of a patient with a TBI and the greatexistent symptoms. Previous clinical studies have clinical success achieved in the reduction of pain, asshown that Low Level Laser Therapy (LLLT) can
  2. 2. measured by VAS - achievable within five treatments injury which occurred in May of 2010. He was attackedof 10 minutes in duration. and repeatedly hit over the head with a lead pipe, consequently requiring many sutures and leaving a scarKeywords: Traumatic Brain Injury; Low Level Laser on the brain as evidenced by the MRI performedTherapy; LLLT; Chronic Migraines; Headaches subsequent to the incident. Since the attack, he has been experiencing excruciating migraines daily which he rates at ranging from 7/10 to 10/10 using a Visual Analog1. INTRODUCTION Scale (VAS) reference and physically describes them as:Traumatic brain injury (TBI) typically occurs when there throbbing, squeezing sensations located primarily to theis any sudden trauma to the skull that induces damage to occipital region of his skull. He complains of beingthe brain. There are many causes of TBIs, but unable to have a peaceful night of sleep or to participateunfortunately no documented cures. According to Faul et in play with his four children, the oldest being 9, due toal., the annual incidence of TBI in the United States is the constant pain and agony he experiences.approximately 1.7 million incidents, which account for After undergoing multiple previous treatment30.5% of injury related deaths[1]. The direct and indirect modalities, which included: medications, vitamincosts of TBI totaled an estimated 76.5 billion dollars in supplements, and chiropractic massage therapies, all ofthe United States in 2000 [2]. Traumatic brain injuries which were unsuccessful at alleviating his symptoms, heplay a major role in the health care of our nation, had all but given up hope. Willing to try anything to ridespecially in our armed forces, where the men and himself of the chronic pain, he agreed to undergo LLLTwomen serving our country are at a higher risk to suffer a treatment. Using a Theralase® superpulsed LLLTTBI. medical laser system equipped with a multiple probe Treatment is centered on preventing future insult to handpiece (5 x 905 nm wavelength @ 0 to 100 mWthe brain, but very little can be done to treat the already average power per laser diode + 4 x 660 nm wavelengthexisting symptoms. These symptoms, as described by the @ 25 mW average power per laser diode), he was givenNational Institutes of Health, range from mild to severe a total of five treatments delivered over a two weekand include: headaches, nausea, vomiting, confusion, and period, with the 905 nm laser diodes set to 50 mWblurry vision. Current theory on alleviating the symptoms average power. The LLLT was targeted to a total of fourof TBIs is based on reducing inflammatory and oxidative areas on the scalp for two and a half minutes each:stress and increasing perfusion to support metabolic midline occipital region just below the lamboidal suture,needs [3]. A study by Naeser et al. looked at the use of superior aspect of the nape to target the Circle of WillisNear Infra Red (NIR) light for the treatment of TBI, and over the mastoid processes bilaterally. We selectedstroke, and neurodegenerative disease. Their results were 905nm wavelength based on a previous scientific studyvery promising, showing that nightly treatments with that demonstrated that the 905 nm superpulsedNIR LED over a period of months to years improved wavelength employed by the system was able to increasecognitive abilities [4]. Furthermore, they showed that the inducible Nitric Oxide Synthase (iNOS) expression byuse of NIR light increased ATP production, caused 700%, as compared to numerous other wavelengths thatvasodilation, and improved perfusion. We believe that showed little or no effect [5]. iNOS has been wellthe superpulsed 905 nm LLLT system employed in this documented in numerous clinical studies to causecase study operates through similar mechanisms of action temporary vasodilation by signaling endothelial cellsand to support our hypothesis we present a case report of located in capillary walls to become flaccid and relax.a patient with a traumatic brain injury that was treated Additional studies have shown that 810 nm and 665 nmwith the superpulsed 905 nm LLLT system two years wavelengths may also be effective, but those specificafter the injury occurred. wavelengths are not able to produce as much iNOS expression, when compared to 905 nm superpulsed2. CASE REPORT technology [6]. An average power for the superpulsedA 25 year old man with no pertinent past medical history 905 nm laser diodes was initially chosen to be 50mWpresented as a new patient. His only complaint was based on personal experience, but further clinicalchronic debilitating migraines since a traumatic brain
  3. 3. investigations may uncover more clinically effective weeks and 5 months post treatment, does carpentry workaverage power settings. with his father and remains symptom free. He is deeply Immediately after the first treatment of only ten appreciative of the care he was given and continues tominutes in duration, the patient reported a 43% reduction enjoy family life which was impossible before LLLT.in pain, reporting a VAS of 4/10 from a pre-treatment More research needs to be done, especially controlledscore of 7/10. He stated the throbbing and squeezing double blind studies to further evaluate the fullnature of his pain had immediately subsided and that all effectiveness and possible side effects of using LLLT inthat was left was more of a dull achy pain. He continued the treatment of TBIs and migraines, but the latestwith the treatments over the next week and with each research has shown that LLLT is an extremely safe andnew treatment his pain was further reduced. By the end effective technology for a wide range of neural andof the course of 5 treatments, his pain had reduced by muscular skeletal conditions.over 90% and all that remained was a minor ache that Note: Mr. Banas has successfully treated over 65was barely even noticeable. Furthermore, he reported no migraine patients not all of whom were victims of a TBIside effects from the treatment except for a slight but except for a few instances gave the a patients lifesensation of warmth over the area where the laser was changing , significant relief.placed. He was no longer experiencing constant pain;even his children noticed the difference saying that he REFERENCESlooked happier. After two years, he was finally able to 1. Faul M, X.L., Wald MM, Coronado VG, Traumaticachieve a good night’s rest. brain injury in the United States: emergency department visits, hospitalizations, and deaths. 2010. 2. Finkelstein E, C.P., Miller T and associates, The3. DISCUSSION Incidence and Economic Burden of Injuries in theLow Level Laser Therapy (LLLT) has been used in many United States. Oxford University Press, 2006.acute and chronic conditions, but its effectiveness is yet 3. Sahni, T., et al., Use of hyperbaric oxygen into be fully documented by human clinical trials for traumatic brain injury: retrospective analysis of datamigraine, stroke or TBI. Currently Dr. Michael Whalen, of 20 patients treated at a tertiary care centre. Br J Neurosurg, 2012. 26(2): p. 202-7.working at Massachusetts General Hospital, is 4. Naeser, M.A. and M.R. Hamblin, Potential forconducting controlled studies using a low level laser with transcranial laser or LED therapy to treat stroke,the hopes of bringing this new technology into the traumatic brain injury, and neurodegenerativeforefront of neuroscience and medicine. This case study disease. Photomed Laser Surg, 2011. 29(7): p. 443-6.gives one example of how LLLT can be used to treat 5. Moriyama, Y., et al., In vivo effects of low level laserchronic migraines, specifically those that are a result of therapy on inducible nitric oxide synthase. Lasers Surg Med, 2009. 41(3): p. 227-31.traumatic brain injuries. LLLT has been shown to reduce 6. Wu, Q., et al., Low-level laser therapy for closed-pain and inflammation, create a state of vasodilation by head traumatic brain injury in mice: effect ofactivating the nitric oxide pathway and further even different wavelengths. Lasers Surg Med, 2012. 44(3):promote angiogenesis. The present theory is that by p. 218-26.increasing blood flow to the brain, and subsequently,increasing oxygen delivery to the brain, the symptoms ofa migraine can be mitigated. This case differs fromprevious studies performed using laser therapy to helppatients with TBIs in that the type of laser and thesettings used were unique. Specifically, unlike the LEDlight used by Naeser et al., the therapeutic laser weutilized only required five treatments over two weeks tobe effective with immediate results after the firsttreatment. It is currently unclear whether or not our patient willneed maintenance therapy. He was interviewed at two